Psychology of Addiction
Gambling
Keith Clements
Aims
To examine the status of gambling as
a behavioural addiction.
To discuss theories of the origins of
problem gambling.
To consider how such theories may
contribute to helping problem
gamblers.
Identification of problems
 DSM-III included pathological gambling in 1980.
Diagnostic criteria parallel those for drug
dependence.
 The South Oaks gambling screen is widely used as
a means of identifying potential problem gamblers.
 Problems often follow a big win. Problems seem
particularly likely if initial gambling experience
results in winning.
Explanations
 Psychodynamic- gambling as self-punishment
 Psychophysiological- gambling as ‘adrenaline
addiction’
 Cognitive- gambling reflects systems of belief
The South Oaks gambling screen
‘At risk’ items
1-4 some problem, 5+ possible pathological gambler
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Going back to win back lost money most or all of the time
Claiming to have won when had actually lost
Feels gambling is a problem
Gambled more than intended
Others criticized gambling
Felt guilty about gambling
Wanted to stop but didn’t think they could
Concealed evidence of gambling from family
Argued with others over gambling
Unpaid debts because of gambling
Absent from work or school due to gambling
Orford et al (2003)
 British gambling prevalence survey found 0.8% of a
representative sample scored above 5 on the SOGS
 0.6% met DSM-IV criteria.
 Men outnumbered women 2-3x
 Problem gambling was particularly common amongst
younger men.
 Gambling problems were more common in single
individuals than in those who were married or
cohabiting, although only the SOGS criteria indicated
higher levels of problem gambling amongst divorced
and separated participants.
 Problem gambling was negatively correlated with
income, individuals in lower income brackets had
higher frequencies of problem gambling.
Gambling as an addiction
 Several studies provide evidence for similarities between
problem gambling and drug addiction.
 Wray and Dickerson (1981) report that gamblers who are
prevented from gambling often report psychological changes
resembling withdrawal symptoms.
 However, such symptoms may not be as intense as those
following drug use.
 Orford et al. (1996) gave alcoholics and problem gamblers
(n=16) measures of attachment to drinking/gambling,
withdrawal symptoms and dependence.
 The two groups reported similar levels of attachment, but
problem gamblers reported less intense withdrawal
symptoms (physical and psychological) and less dependence.
Other features of dependence?
This perspective usually presents gambling as an
addiction motivated by the excitement or arousal
gambling induces.
Griffiths (1993), used psychophysiological measures
to examine the effects of gambling on fruit machines.
Regular gamblers showed a heart rate increase which,
while equivalent in magnitude, was less sustained than
that of non-regular gamblers. Griffiths interprets
this as evidence for tolerance.
A number of recent studies indicate that heart rate
increases are particularly associated with winning and
with the expectation of winning money, as opposed to
the activity itself (Coventry & Hudson, Ladouceur et
al. 2003.
Cognitive accounts
 Gambling can also be approached from a different
perspective. Many studies examine the cognitive
bases of gambling. e.g. Griffiths (1994) used a
version of protocol analysis to examine the
cognitions of regular fruit machine gamblers. He
describes cognitive biases in regular gamblers,
which would sustain their gambling.
 Several general theories of decision making have
been applied to gambling.
Normative decision theory .
Describes how actions with uncertain outcomes can be
chosen on the basis of their expected outcome.
Various modifications have been proposed to explain
gambling while still assuming that human decision
making follows these rational rules. E.g.
 Gamblers may attach greater significance to
winning than to loosing.
 The action of gambling itself may also have a
positive value.
 Gamblers may focus on short-term outcomes,
rather than average outcomes over the long-term.
In practice peoples’ decision making very rarely follows
the predictions of normative decision theory.
Heuristics and biases
 Heuristics and biases theory has also been applied
to gambling. This approach documents the
heuristics which guide human decision making.
These often cause human reasoning to depart
from purely rational principles. This approach
provides several heuristics which can explain
gambling.
Heuristics & Biases as an explanation
Representativeness bias reflects the belief that
global properties will be reflected in local series e.g.
that tossing a coin a small number of times must
produce even numbers of heads and tails and that
long runs of one outcome will not occur. A similar
belief, that runs of ‘bad luck’ must be followed by
good luck is known as the gambler’s fallacy.
However the approach does not adequately specify
when a given heuristic will be applied. What is
needed are rules specifying when and how one of the
available heuristics will be chosen over others
Integration
 These two approaches need not be viewed as
distinct. Two papers provide similar attempts to
integrate
arousal
and
cognition-based
explanations.
 Both Sharpe & Tarrier (1993) and Orford et al.
(1996) propose that gambling is initially
maintained by the excitement generated by
gambling and occasional monetary gains.
 Both emphasise the importance of other factors
as gambling escalates.
Sharpe & Tarrier (1993)
 Propose that the physiological effects of gambling are
cognitively-mediated. Initially gambling is maintained by operant
conditioning. Excitement generated by gambling and occasional
monetary gains encourage further gambling.
 If gambling continues cognitive mechanisms become more
important. Links between environmental cues, arousal and
gambling-related cognitions are strengthened. Beliefs which
discount losses and encourage undue optimism come to be
triggered by arousal and/or environmental cues.
 Sharpe et al. (1995), found that distracting regular gamblers
while they watched a video of a poker machine, i.e. disrupting
the cognitive activity generated by the video, prevented the
increase in skin conductance which characterised this group in
the absence of distraction.
The development of problem gambling
Sharpe & Tarrier stress the importance of coping
skills in protecting individuals from developing
gambling problems.
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Relevant coping skills include:
Control over autonomic arousal
The ability to challenge cognitions
Problem-solving skills
The ability to delay reinforcement
The consequences of continued losses may undermine
such coping skills. These consequences might include:
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Low-self esteem
Alcohol use
Financial difficulties
Stress
Social Pressure
Orford et al. (1996)
Describe four secondary factors which become more
important as gambling becomes more frequent:
 Drive for money
 Chasing losses
 Secrecy
 Cognitive defence.
Once problem gambling develops the consequences
may motivate further gambling or remove
restraints
 e.g. Orford et al. identify loss of a job, divorce
and low self-esteem as tertiary factors.
Orford et al’s model
Controlling
factors
Positive
experience
of
Gambling
Escalating
factors
Secrecy
Cognitive
defence
Strong
attachment
Drive for
money
Harm
Contemplation
of change
Chasing
losses
Negative
experience
of gambling
From Orford, Morison & Somers (1996)
Treatment
Gamblers Anonymous applies the 12-step model originally
developed by AA
 Gambling as a lifelong disease requiring abstinence
Treatment programs typically emphasise family involvement.
Very few controlled studies of treatment effectiveness.
López Viets & Miller (1997) Reviewed treatment outcome
studies.
 They report that the evidence showed cognitive-behavioural
interventions to be effective. They could find only 4
controlled trials- these generally favoured cognitivebehavioural treatments, including imaginal desensitization
and stimulus identification and exposure. Other therapies
had generally been evaluated only in case studies.
Legg England & Götestam (1991)
 suggest the following components of treatment
 Removing conditioned stimuli for gambling
 Establish alternative means of financial
control
 Reduce financial need
 Establish alternative means of controlling
internal states
Reduce negative internal states
Cognitive therapies
Current trends include interventions based on multidimensional
models, such as those above, and cognitive therapies. Griffiths
(1993) suggested that presenting gamblers with their own
tape-recorded verbalisations may motivate behaviour change.
Sharpe & Tarrier (1992)
Describe a case study of cognitive therapy for problem
gambling. Components include:
 Self-monitoring to identify physiological and cognitive
Reactions to gambling situations
 Relaxation training to counter physiological arousal
 Imaginal exposure followed by in vivo exposure
 Cognitive restructuring
Cognitive Therapies
 Petry (2004) reviewed four randomised controlled trials
which included cognitive therapies.
 Included a package consisting of problem-solving and social
skills training, relapse prevention and cognitive restructuring
(Sylvain, Ladoucer & Boisvert, 1997); A programme intended
to alter erroneous perceptions and improve understanding of
randomness either as individual (Ladouceur et al., 2001); or as
group therapy (Ladouceur et al., 2003) and cognitive
restructuring, in a group format (Echeburúa, Baez &
Fernandez-Montalvo, 1996).
 In all except the last, cognitive therapy provided significant
improvements compared to a waiting list control. However
around 40% of clients dropped out before completing the
package.
Further Reading
Lamberton A & Oei TPS (1997). Problem gambling in
adults: An overview. Clinical Psychology and
Psychotherapy. 4, 84-104.
provides a detailed overview of work on problem
gambling, written from a clinical perspective.
Petry, N. (2004). Pathological Gambling: Etiology,
Comorbidity & Treatment. Washington: APA.
Blaszczynski, A. & Nower, L. (2002). A pathways model
of problem and pathological gambling. Addiction 97
(5), 487-499.
Specific Articles
Sharpe L & Tarrier N (1993). Towards a cognitive-behavioral
theory of problem gambling. British Journal of Psychiatry.
162, 407-412.
Shaffer, H.J. (1999). Strange bedfellows: A critical view of
pathological gambling and addiction. Addiction, 94, 14451448.
Dickerson M. & Baron, E. (2000). Contemporary issues and
future directions for research into pathological gambling.
Addiction, 95, 1145-1159.
Orford, J., Morison, V. & Somers, M (1996) Drinking and
gambling: A comparison with implications for theories of
addiction. Drug Alcohol Review, (15) pp.47-56
-available from the library digital resources page.